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Tumor necrosis factor-blocking agents for children with enthesitis-related arthritis - data from the Dutch Arthritis and Biologicals in Children Register, 1999-2010
Journal of Rheumatology, 08/19/2011
Clinical Article
Otten MH et al. – Tumor necrosis factor (TNF)–blocking agents seem effective and safe for patients with ERA that was previously unresponsive to 1 or more DMARD. However, a sustained disease–free state could not be achieved, and none discontinued TNF–blocking agents successfully.
Methods- All patients with ERA in whom a biological agent was initiated between 1999 and 2010 were selected from the Dutch Arthritis and Biologicals in Children (ABC) register
- Ongoing multicenter observational register
- Data on course of disease and medication use are retrieved prospectively at the start of the biological agent, after 3 months, and yearly thereafter
- Inactive disease assessed in accordance with Wallace criteria
- 22 patients with ERA started taking 1 or more biological agents: 20 took etanercept, 2 took adalimumab (1 switched from etanercept to adalimumab), and 2 took infliximab (1 switched from etanercept to infliximab)
- Characteristics: 77% were male, 77% had enthesitis, 68% were HLA–B27–positive
- Median age of onset was 10.4 (IQR 9.4–12.0) years; median followup from the start of the biological agent was 1.2 (IQR 0.5–2.4) years
- Intention–to–treat analysis shows that inactive disease was achieved in 7 of 22 patients (32%) after 3 months, 5 of 13 patients (38%) after 15 months, and 5 of 8 patients (63%) after 27 months of treatment
- 2 patients discontinued etanercept because of ineffectiveness, and switched to adalimumab (inactive disease achieved) or infliximab (decline in joints with arthritis after 3 months of treatment)
- 1 patient discontinued etanercept because of remission, but had flare and restarted treatment, with good clinical response
- No serious AEs occurred
